Kidney Week

Abstract: TH-PO989

Association Between Histologic Variants of Focal Segmental Glomerulosclerosis and Outcomes: Results from the Japan Renal Biopsy Registry

Session Information

• Glomerular Diseases: Minimal Change Disease, FSGS, IgAN
  November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Kawaguchi, Takehiko, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan

Takehiko Kawaguchi,

• Imasawa, Toshiyuki, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan

Toshiyuki Imasawa,

• Kitamura, Hiroshi, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan

Hiroshi Kitamura,

• Kadomura, Moritoshi, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan

Moritoshi Kadomura,

• Maruyama, Shoichi, Nagoya University Graduate School of Medicine, Nagoya, Japan

Shoichi Maruyama,

• Ozeki, Takaya, Nagoya University Graduate School of Medicine, Nagoya, Japan

Takaya Ozeki,

• Katafuchi, Ritsuko, National Hospital Organization Fukuokahigashi Medical Center, Koga, Fukuoka, Japan

Ritsuko Katafuchi,

• Oka, Kazamasa, Hyogo Prefectural Nishinomiya Hospital, Hyogo Nishinoniya, Japan

Kazamasa Oka,

• Isaka, Yoshitaka, Osaka University Graduate School of Medicine, Suita, Japan

Yoshitaka Isaka,

• Yokoyama, Hitoshi, Kanazawa Medical University, Ishikawa, Japan

Hitoshi Yokoyama,

• Sugiyama, Hitoshi, Okayama University Graduate School, Okayama, Japan

Hitoshi Sugiyama,

• Sato, Hiroshi, Clinical Pharmacology and Therapeutics, Graduate School of pharmaceutical Sciences, Tohoku University, Sendai, Miyagi, Japan

Hiroshi Sato,

Background

Focal Segmental Glomerulosclerosis (FSGS) is a leading cause of end stage kidney disease (ESKD). The previous studies suggested that FSGS histologic variants of the Columbia classification were associated with clinical outcomes, but the impact of FSGS variants on outcomes has not comprehensively been investigated in Japan.

Methods

Data on patients with primary FSGS of Japan Renal Biopsy Registry from 2010 to 2013 were analyzed. The outcome measures were 30% decline in estimated glomerular filtration rate (GFR30), progression to ESKD, and the first clinical remission (CR: proteinuria<0.3g/day) during 60 months after the biopsy. Multivariable Cox models were used to compare the outcomes among variants, adjusted for age, sex, baseline eGFR, nephrotic proteinuria (NP), and immunosuppressive treatment (IS).

Results

311 patients were enrolled [median age: 52 (IQR 33, 66) years, male: 63%; baseline eGFR: 58 (IQR 40, 80) ml/min/1.73m², NP: 54%, IS: 54%]. The distribution of variants was 47% (n=147) FSGS not otherwise specified (NOS), 19% (n=59) tip (TIP), 16% (n=50) perihilar (PERI), 13% (n=40) cellular (CEL), and 5% (n=15) collapsing (COL). During the follow-up, 87 patients (28%) developed GFR30, 25 (8%) ESKD, and 118 (38%) reached CR. No significant differences in GFR30 and ESKD were found among variants, but TIP was significantly associated with CR compared with PERI [adjusted HR (95% CI), 2.2 (1.0, 4.8) (Figure).

Conclusion

Based on the Japanese national registry in the modern era, FSGS variants did not have a significant impact on GFR30 or ESKD during 60 months, while the variant types were associated with CR. Larger sample size, especially for COL, and longer follow-up may be needed to detect a statistically significant difference in the outcomes among FSGS variants.

Funding

• Government Support - Non-U.S.